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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 2390 - 28 August 2019 Posted By: Dr. Hafeez Diwan

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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31 year-old female with rash on her legs. There are reticulated hyperpigmented patches and plaques, from mid thighs to feet. There are scattered eroded to crusted papules and several tender subcutaneous nodules.


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Dr. Hafeez Diwan

Posted

Clinically, the suspicion was of polyarteritis nodosa.  There is vascular necrosis with lymphocytes and thrombi in the subcutaneous fat.  So I called it vasculitis and considered lymphocytic thrombophilic artertitis, 

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Meenakshi Batrani

Posted

9 hours ago, Dr. Hafeez Diwan said:

Clinically, the suspicion was of polyarteritis nodosa.  There is vascular necrosis with lymphocytes and thrombi in the subcutaneous fat.  So I called it vasculitis and considered lymphocytic thrombophilic artertitis, 

I also thought of PAN, which may manifest as thrombosis of small vessels or thrombophilic arteritis (considered as indolent variant of PAN). The reticulate pigmentation and subcutaneous nodules are congruent with cutaneous PAN. I was confused for crusted papules- ?is this clinical morphology unusual for PAN or is it known.

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